Intelligent medical escalation process

ABSTRACT

A medical network service can replace or supplement some or all of an expensive internally staffed clinical facility network with a cloud-based networking service. The medical network service in certain embodiments can provide networking services via software as a service technologies, platform as a service technologies, and/or infrastructure as a service technologies. The medical network service can provide these services to large existing clinical facilities such as metropolitan hospitals as well as to smaller clinical facilities such as specialized surgical centers. The medical network service can replace and/or supplement existing IT networks in hospitals and other clinical facilities and can therefore reduce costs and increase security and reliability of those networks. In addition, the medical network service can provide synergistic benefits that can improve patient outcomes and patient care. In addition, a medical edge router can provide redundant communications features for transmitting patient data to the medical network service.

INCORPORATION BY REFERENCE TO ANY RELATED APPLICATIONS

Any and all applications, if any, for which a foreign or domesticpriority claim is identified in the Application Data Sheet of thepresent application are hereby incorporated by reference under 37 CFR1.57.

BACKGROUND

Hospitals, nursing homes, and other patient care facilities typicallyinclude patient monitoring devices at one or more bedsides in thefacility. Patient monitoring devices generally include sensors,processing equipment, and displays for obtaining and analyzing a medicalpatient's physiological parameters. Physiological parameters include,for example, respiratory rate, SpO₂ level, pulse, and blood pressure,among others. Clinicians, including doctors, nurses, and certain othermedical personnel use the physiological parameters obtained from themedical patient to diagnose illnesses and to prescribe treatments.Clinicians also use the physiological parameters to monitor a patientduring various clinical situations to determine whether to increase thelevel of medical care given to the patient.

Patient monitors capable of measuring pulse oximetry parameters, such asSpO₂ and pulse rate in addition to advanced parameters, such as HbCO,HbMet and total hemoglobin (Hbt) and corresponding multiple wavelengthoptical sensors are described in at least U.S. patent application Ser.No. 11/367,013, filed Mar. 1, 2006 and entitled Multiple WavelengthSensor Emitters and U.S. patent application Ser. No. 11/366,208, filedMar. 1, 2006 and entitled Noninvasive Multi-Parameter Patient Monitor,both assigned to Masimo Laboratories, Irvine, Calif. (Masimo Labs) andboth incorporated by reference herein. Further, noninvasive bloodparameter monitors and corresponding multiple wavelength opticalsensors, such as Rainbow™ adhesive and reusable sensors and RAD57™ andRadical-7™ monitors for measuring SpO₂, pulse rate, perfusion index,signal quality, HbCO and HbMet among other parameters are also availablefrom Masimo Corporation, Irvine, Calif. (Masimo).

Advanced physiological monitoring systems may incorporate pulse oximetryin addition to advanced features for the calculation and display ofother blood parameters, such as carboxyhemoglobin (HbCO), methemoglobin(HbMet) and total hemoglobin (Hbt or SpHb), as a few examples. Advancedphysiological monitors and corresponding multiple wavelength opticalsensors capable of measuring parameters in addition to SpO₂, such asHbCO, HbMet and Hbt are described in at least U.S. patent applicationSer. No. 11/367,013, filed Mar. 1, 2006, titled Multiple WavelengthSensor Emitters and U.S. patent application Ser. No. 11/366,208, filedMar. 1, 2006, titled Noninvasive Multi-Parameter Patient Monitor,incorporated by reference herein. Further, noninvasive blood parametermonitors and corresponding multiple wavelength optical sensors, such asRainbow™ adhesive and reusable sensors and RAD-57™ and Radical-7™monitors for measuring SpO₂, pulse rate, perfusion index (PI), signalquality (SiQ), pulse variability index (PVI), HbCO and HbMet among otherparameters are also available from Masimo.

SUMMARY

For purposes of summarizing the disclosure, certain aspects, advantagesand novel features of several embodiments have been described herein. Itis to be understood that not necessarily all such advantages can beachieved in accordance with any particular embodiment of the embodimentsdisclosed herein. Thus, the embodiments disclosed herein can be embodiedor carried out in a manner that achieves or optimizes one advantage orgroup of advantages as taught herein without necessarily achieving otheradvantages as can be taught or suggested herein.

This disclosure describes embodiments of a medical network service thatcan replace or supplement some or all of an expensive internally staffedclinical facility network with a cloud-based networking service. Themedical network service in certain embodiments can provide networkingservices via software as a service (SaaS) technologies, platform as aservice (PaaS) technologies, and/or infrastructure as a service (IaaS)technologies. The medical network service can provide these services tolarge existing clinical facilities such as metropolitan hospitals aswell as to smaller clinical facilities such as specialized surgicalcenters. The networking services provided by the medical network servicecan replace and/or supplement existing IT networks in hospitals andother clinical facilities and can therefore reduce costs and increasesecurity and reliability of those networks. In addition, the medicalnetwork service can provide synergistic benefits that can improvepatient outcomes and patient care.

In certain embodiments, a method of providing patient monitoring dataover a network may include, by a medical edge router having one or morehardware processors, receiving input packets with the medical edgerouter, where the input packets include information related to patientmonitoring data, analyzing the input packets to identify any patientmonitoring alarms in the input packets, transmitting first ones of theinput packets that do not correspond to a patient alarm over a firstcommunications channel, and in response to detecting a patientmonitoring alarm in second ones of the input packets, transmitting thesecond packets over multiple second communications channels.

In certain embodiments, a system for providing patient monitoring dataover a network can include a medical edge router having one or morehardware processors. The medical edge router can include a trafficinspector that can receive input packets including information relatedto patient monitoring data and to analyze the input packets to identifyany patient monitoring alarms in the input packets. Further, the medicaledge router can include a routing module that can transmit first ones ofthe input packets that do not correspond to a patient alarm over a firstcommunications channel and transmit second ones of the input packetsover multiple second communications channels in response to detecting apatient monitoring alarm in the second input packets.

In certain embodiments, a method of providing patient monitoring dataover a network can include, by a medical edge router having one or morehardware processors, receiving input data with the medical edge router.The input data can include information related to patient monitoringdata. The method may also include attempting to transmit the input dataover a first communications channel. Further, the method may include, inresponse to determining that the first communications channel isunavailable, attempting to transmit the input data over a secondcommunications channel. Moreover, the method may include, in response todetermining that the second communications channel is unavailable,transmitting a reduced form of the input data over a thirdcommunications channel.

In certain embodiments, a method of configuring a patient profile in apatient monitoring device can include, by a medical network serviceincluding one or more hardware processors, determining whether a patientadmitted to a clinical facility is associated with an existing alarmsettings profile stored with the medical network service. The method mayalso include, in response to determining that the patient is associatedwith the existing alarm settings profile, assigning the existing alarmsettings profile to a monitoring device associated with the patient.Further, the method may also include, in response to determining thatthe patient is not associated with an existing alarm settings profile:identifying a matching alarm profile template that matches one or moreattributes of the patient, and assigning the matching alarm profiletemplate to the monitoring device.

The method of the preceding paragraph may include any combination of thefollowing features. For instance, the method may further includeobtaining the one or more attributes of the patient when the patient isadmitted to the clinical facility. The one or more attributes of thepatient can include one or more of the following attributes: age,gender, health condition, and medication associated with the patient.The identifying of the matching alarm profile template can includeselecting a neonate alarm template in response to determining that theage of the patient corresponds to a neonate. The neonate alarm templatecan have different alarm settings than an adult alarm template. Further,the method may also include presenting the matching alarm profiletemplate to a clinician for approval prior to assigning the matchingalarm profile template to the monitoring device. The method may alsoinclude presenting the matching alarm profile template to a clinicianfor customization prior to assigning the matching alarm profile templateto the monitoring device. The existing alarm settings profile may begenerated at a second clinical facility different from the clinicalfacility and stored in computer storage for subsequent access.

In certain embodiments, a system for configuring a patient profile in apatient monitoring device can include a medical network service havingone or more hardware processors. The medical network service candetermine whether a patient admitted to a clinical facility isassociated with an existing alarm settings profile stored with themedical network service. In response to determining that the patient isassociated with the existing alarm settings profile, the medical networkservice can also assign the existing alarm settings profile to amonitoring device associated with the patient. In response todetermining that the patient is not associated with an existing alarmsettings profile, the medical network service can also identify amatching alarm profile template that matches one or more attributes ofthe patient and associating the matching alarm profile template with thepatient.

The system of the preceding paragraph may include any combination of thefollowing features. For instance, the medical network service may alsoobtain the one or more attributes of the patient when the patient isadmitted to the clinical facility. The one or more attributes of thepatient comprise one or more of the following attributes: age, gender,health condition, and medication associated with the patient. Themedical network service can also identify the matching alarm profiletemplate by at least selecting a neonate alarm template in response todetermining that the age of the patient corresponds to a neonate. Theneonate alarm template may have different alarm settings than an adultalarm template. The medical network service may also present thematching alarm profile template to a clinician for approval prior toassociating the matching alarm profile template with the patient. Themedical network service may also present the matching alarm profiletemplate to a clinician for approval prior to associating the matchingalarm profile template with the patient. The existing alarm settingsprofile may be generated at a second clinical facility different fromthe clinical facility and stored in computer storage for subsequentaccess.

BRIEF DESCRIPTION OF THE DRAWINGS

Throughout the drawings, reference numbers are re-used to indicatecorrespondence between referenced elements. The drawings are provided toillustrate embodiments of the inventions described herein and not tolimit the scope thereof.

FIG. 1 depicts an embodiment of a computing environment in which variouscomputing devices and patient monitoring devices can obtain networkservices from a medical network service.

FIG. 2 depicts a more detailed embodiment of the medical network serviceof FIG. 1.

FIG. 3 depicts an embodiment of a patient profile configuration process.

FIG. 4 depicts an embodiment of a device profile configuration process.

FIG. 5 depicts an example device configuration adjustment userinterface.

FIG. 6 depicts an embodiment of a continuum of care process.

FIG. 7 depicts an embodiment of a situational alarm context process.

FIG. 8 depicts an embodiment of a situational escalation process.

FIG. 9 depicts another embodiment of a computing environment in whichvarious computing devices and patient monitoring devices can obtainnetwork services from a medical network service.

FIG. 10 depicts an embodiment of a medical edge router.

FIG. 11 depicts an embodiment of an edge router failover process.

FIG. 12 depicts an embodiment of an edge router alarm handling process.

DETAILED DESCRIPTION I. Introduction

A trend in hospitals today is to move away from big box hospitals thatprovide all services typically provided by hospitals and to providesmaller community hospitals closer to people in suburban communities.The smaller community hospitals can be more specialized and may, forexample, include surgical centers that specialize in a few types ofsurgery or even a single type of surgery. Smaller community hospitalscan provide efficiency gains in time and healthcare costs by beingcloser to patients and by focusing on a few areas of specialties.However, a drawback from having such facilities is that these facilitiestend not to have the same financial capability as larger hospitalorganizations and therefore tend not to be able to afford expensiveinformation technology network infrastructure for communicating betweenpatient monitoring devices and clinician devices. In addition, suchfacilities typically also may not have the resources to purchase anelectronic medical records (EMR) system, paging systems, or othersystems that can be useful in caring for patients.

Furthermore, such systems can be expense for large hospitals to maintainas well. Hospitals prefer to focus on caring for patients rather thanmanaging information technology and hospital networks. However, due tothe realities of modern medical practice, many large hospitals and otherclinical facilities have entire information technology (IT) departmentsto deal with internal networking issues including, for example, servermaintenance and wireless networking maintenance. Because hospitals havea core competency in providing care for patients, hospitals tend to hirequalified IT personnel to staff their IT departments. However, ashospitals tend to reduce costs to improve patient care while impactingpatients less financially, there is a risk that hospitals may be forcedto cut IT costs for their IT departments and, as a result, mayunintentionally compromise security and ultimately patient safety due tolower reliability of hospital networks.

This disclosure describes embodiments of a medical network service thatcan replace or supplement some or all of an expensive internally staffedclinical facility network with a cloud-based networking service. Themedical network service in certain embodiments can provide networkingservices via software as a service (SaaS) technologies, platform as aservice (PaaS) technologies, and/or infrastructure as a service (IaaS)technologies. The medical network service can provide these services tolarge existing clinical facilities such as metropolitan hospitals aswell as to smaller clinical facilities such as specialized surgicalcenters. The networking services provided by the medical network servicecan replace and/or supplement existing IT networks in hospitals andother clinical facilities and can therefore reduce costs and increasesecurity and reliability of those networks. In addition, the medicalnetwork service can provide synergistic benefits that can improvepatient outcomes and patient care.

In addition, various embodiments of a medical edge router are describedherein. The medical edge router can be an intelligent edge router or thelike that provides redundant communications features for transmittingpatient data to the medical network service.

II. Medical Network Service Embodiments

Turning to the Figures, FIG. 1 depicts an embodiment of a computingenvironment 100 in which various computing devices and patientmonitoring devices can obtain network services from a medical networkservice 110. Various institutions 112, 114, 116 and devices 118, 120 areshown in the computing environment 100. These institutions includesurgery centers/clinics/outpatient care centers (collectively referredto herein as small clinics 112), major hospitals 114, external entitiessuch as government agencies 116. The example devices 118, 120 showninclude home/mobile clinician devices 118, and home/mobile patientdevices 120. The various institutions 112, 114, and 116 may each includeinternal networks of devices having computing devices and patientmonitoring devices that communicate over networks 108 with the medicalnetwork service 110. The medical network service 110 can provide theusers of the institutions 112, 114, and 116 with access to a variety offeatures that are typically included in an internal IT networkinstallation at a hospital, some examples of which include electronicmedical records or EMR, paging systems, wellness index computationalservices, and the like.

In addition, the MNS 110 can communicate with the home/mobile cliniciandevices 118 over a network 108 and the home mobile patient devices 120of a network 108. The example networks 108 shown can be local areanetworks (LAN), wide area networks (WAN), the Internet, an intranet,combinations of the same or the like. Any type of clinician computingdevice 118 can communicate with the MNS 110 including, for example,laptops, desktops, servers, work stations, tablets, wireless handhelddevices such as cell phones, smart phones, personal digital assistantsand wireless pagers, combinations of the same or the like. Likewise, theMNS 110 can communicate with any type of patient monitoring device 120including bedside devices, body worn devices, telemetry devices, and thelike. Any of these patient devices 112 can output parameter data, trenddata and/or alarms which can be provided to the MNS 110 over the network108 and then re-routed by the MNS 110 to institutions 112, 114, orcomputers thereof, and mobile clinician devices 118.

Advantageously, in certain embodiments, by providing network services tothe various entities shown, the MNS 110 can provide greater reliability,security and therefore patient safety compared to existing networks inhospitals and other clinical facilities. The MNS 110 may be implementedin one or more computing devices, such as servers, which may begeographically located, for example, in a data center, or which may begeographically disbursed, for example, in multiple data centers. The MNS110 can include enterprise-class networking capabilities of any state ofthe art or currently available data center today including, for example,load balancing features, failover features, intelligent network problemdetection and resolution features, and the like.

Thus for example, one benefit that the MNS 110 can provide in contrastwith existing hospital networks is that if a switch or other networkdevice were to fail at an existing hospital network, that network wouldthen go down and deprive patients of necessary care. In contrast, in theMNS 110, if a component such as a switch goes down, the MNS 110 may beable to reroute network traffic through other switches and othercomponents and continue or resume critical patient care services for thevarious institutions and devices shown.

Further, the MNS 110 can be configured such that service levelagreements (SLAs) can be provided to institutions so that guarantees ofservice can be met by the MNS 110. An example SLA guarantee can be thatalarms processed by the MNS 110 can be provided to clinician devices inthe institutions 112, 114 within a specified period of time, such as afew seconds or the like. The MNS 110 may also provide uptime guaranteesthrough SLAs or the like.

Moreover, by providing network services from the cloud, in certainembodiments, the MNS 110 can provide synergistic effects that aregreater than the benefits of simply moving the networking services outof the hospital and into a centralized data center. Many examples ofsynergistic benefits are described in detail with respect to FIGS. 2-8below. However, one example of a synergistic benefit of the MNS 110 incertain embodiments is that patient profiles from different institutionsor clinical facilities can be maintained by the MNS 110 as a singlepatient profile. Thus, if a patient is in a first facility and has aprofile that specifies alarm settings that are unique to that patient'shealth conditions, the MNS 110 can store these alarm settings in thepatient's profile in the cloud. If this patient subsequently is admittedto a different facility, the MNS 110 can provide this second facilitywith access to the patient's profile, including the alarm settings thatwere previously set in the first facility. Patient profiles can enableclinicians to avoid having to re-establish useful alarm settings and/orother monitoring settings for the patient. Furthermore, the MNS 110 canenable these patient profiles to be updated and customized at the secondfacility.

In addition to these features, in certain embodiments any of the datacollected by the MNS 110 can be anonymized and provided to the externalentities 116 including, for example, government agencies or researchinstitutions for demographic and healthcare research purposes,additional examples of which are described below with respect to FIG. 2.

Turning to FIG. 2, a more detailed embodiment of a medical networkservice (MNS) is shown, the MNS 210. The MNS 210 can have all of thefeatures of the MNS 110 described above. In the depicted embodiment, theMNS has several subsystems or modules that can be implemented inhardware and/or software. The example modules or components shown groupfunctionality of embodiments of the MNS 210 together under logicaldescriptions. It should be understood, however, that the various modulesand systems shown in the MNS 210 or portions thereof could beimplemented together in a single system. In addition, not all of thesystems or modules shown need be implemented on the same computingdevice but could instead be implemented in separate computing devices.

The MNS 210 includes, for example, a network management module 202. Thenetwork management module 202 can manage network communications withother networks, including networks in hospitals and other facilities aswell as communications with mobile patient devices and cliniciandevices. For example, the network management module 202 can communicatewith devices in hospitals and outside of hospitals, or inside offacilities and outside of facilities. The network management module 202can provide the networking services described above with respect to FIG.1, such as load balancing, failover, and the like. In addition, if apatient is monitored in a facility that communicates with the networkmanagement module 202, and then the patient is discharged from thefacility, the network management module 202 can maintain connectivitywith a body-worn or other mobile medical device associated with thepatient, for example, over cellular or Wi-Fi links. Additional examplefeatures of the network management module 202 are described below withrespect to FIG. 6.

The MNS 210 also includes an EMR system 204 that can generally storepatient data from any facility, including data collected from patientmonitoring devices in patients' homes or while patients are mobileoutside of their homes or out of facilities. For example, the EMR system204 can include such information as parameter values, trend values,alarm histories, patient demographic data, patient condition dataincluding diagnoses, patient medical histories, and patient medications,among a variety of other patient data. The data in the EMR 204 canadvantageously be used by other components of the MNS 210 as describedbelow to improve patient care.

A clinician portal 206 of the MNS 210 can provide a user interface oruser interfaces that can be accessed by clinicians via their cliniciandevices to monitor the health status of their patients for whom they areresponsible. The clinician portal 206 may, for example, be implementedin one or more web pages, mobile applications, or other networkapplications and may provide information about the wellness or relativewellness of each patient.

In one embodiment, a wellness score or index is computed for eachpatient by a risk analysis system 208 of the MNS 210, and the clinicianportal 206 can depict these wellness indices among other parameter data,trend data and alarms for each patient. In one embodiment, the clinicianportal 206 facilities triaging patients by providing functionality forpatients to be ordered or ranked based on their wellness scores orindices as computed by the risk analysis system 208. Example featuresfor computing wellness indices or risk assessments are described inAppendices IV and V. For example, the risk analysis system 208 can takeinto two or more parameters, such as any combination of the followingparameters: oxygen saturation (e.g., SpO₂), respiratory rate, pulserate, heart rate, total hemoglobin level, methemoglobin,carboxyemoglobin, blood pressure, ECG output, encephalography output, orthe like. The risk analysis system 208 can combine data from suchparameters and reduce this data to a single value or data representationof the combination of those parameters. The single value may be, forexample, an index or score that is on a scale of 0 to 10, where 10 mayrepresent a most healthy state, while 0 may represent a least healthystate. Thus, such scores could be used to rank the relative health stateor acuity of patient sicknesses and such numerical rankings can beoutput for presentation to clinicians in the clinician portal 206,thereby enabling clinicians to quickly triage patients.

Advantageously, in certain embodiments, the risk analysis system 208also leverages aspects of the cloud-based infrastructure of the MNS 210to improve the wellness index calculation. For example, the riskanalysis system 208 may be able to access patient profile data from theMNS 210 that comes from previous hospital visits or other clinicalfacility visits from a single facility or multiple facilities to computehistorical wellness indices or to compute a current wellness index. Therisk analysis system 208 can also personalize the wellness index basedon patient attributes stored in the EMR system 204. For example, therisk analysis system 208 can personalize which parameters are weightedmore heavily in the combination of parameters that are output as awellness index based on previous patient conditions listed in EMR system204. In currently available systems, different institutions typically donot share their EMR data, and EMRs therefore cannot be used to correlatepatient data from multiple institutions together and thereby improverisk analysis and wellness indices. However, such advantages can be madepossible in certain embodiments by the centralized cloud nature of theMNS 210.

The MNS 210 also includes a patient profile manager 211. The patientprofile manager 211 can manage patient profiles, which can includeinformation about patient demographics, patient alarm settings,including alarm settings from previous visits to potentially multipledifferent facilities, patient conditions and so forth, and examplefeatures of which are described in greater detail below with respect toFIG. 3. The MNS 210 further includes a device profile manager 212 thatcan manage and store device profiles for medical devices that interactwith the MNS 210 as well as optionally other computing devices. Theprofiles may have information about rules that can be used to track theusage of these devices as well as a variety of other features, examplesof which are described in greater detail below with respect to FIGS. 4and 5.

The MNS 210 also includes an early warning system 216. The early warningsystem 216 can issue early warning alarms based on parametermeasurements, indices such as the wellness index or other indices. Theearly warning system 216 can look for patterns in patients to facilitatedetecting never events, including events that should occur never orrarely, like a patient dying in bed without any intervention,particularly when a patient is home and would not ordinarily be underthe care of a hospital or have access to a system like the risk analysissystem 208 or the early warning system 216.

An escalation module 218 of the MNS 210 can provide functionality forescalating alarms from a first or primary care provider to a second orsubsequent care provider in case the primary care provider isunavailable. However, the escalation module 218 may also provideadditional functionality such as obtaining information from a remoteprimary care provider and providing this information to a secondarylocal care provider who is local to the patient and can thereforeintervene using the information provided by the first care provider.Such embodiments are described below in greater detail with respect toFIG. 8.

An information exchange system 220 of the MNS 210 facilitatescommunicating information about patients to government or researchinstitutions 118 described above with respect to FIG. 1. One scenariowhere patient information may be submitted (anonymously) to governmentor research institutions is where a disease outbreak has occurred. Forexample, information may be provided that indicates several patients ina hospital have come down with the flu. The information exchange system220 can report this occurrence to an external entity such as the CDC orthe Center for Disease Control, or state or local government agency ornational government agency or worldwide agency to alert such agenciesother institutions of the potentiality of a disease outbreak. Ifmultiple institutions are using the services of the MNS 210, then suchinformation about patient conditions can be correlated and provided tothese institutions as described above. More generally, the informationexchange system 220 can provide data about changing patient conditionscontinuously or periodically to government or research organizations toenable such organizations to rapidly respond to changes in regionalhealth issues.

Further, the data provided by the information exchange system 220 can bevaluable to government agencies or research institutions to determinethe effects of local conditions on health conditions. It may bediscovered, for instance, that patients that go to a specific facilityor set of facilities in a region are afflicted with disease related tonearby coal mining which can be ascertained by research institution or agovernment agency that has responsibility over such activities.Accordingly, the information exchange system 220 can provide value datathat can provide reports that can be used by external entities toimprove patient care.

A journaling module 222 of the MNS 210 can capture clinicianinteractions with medical devices that are in the institutions and/orthat are in patients' homes or that are body worn in mobile situations.The interactions can include any type of button press, alarm settingchange, RFID tag interaction, or the like and can be recorded for thepurposes of determining clinician response times to alarms or othermeasures of the quality of a clinician's care. The journaling module 222can further leverage the centralized monitoring capabilities of the MNS210 to compare the quality of care as journaled or otherwise calculatedamongst different institutions as an apples-to-apples comparison becausesome or all of the data from these institutions can be provided to thecentralized MNS 210.

Further, the journal module 222 can facilitate comparing the quality ofcare between different units in a hospital or other facility includingdifferent floors or groups of clinicians or shifts, or the like. Thejournal module 222 can also facilitate comparing similar groups amongstdifferent facilities, such as an ICU group in two different facilities,and can thereby enable an organization to identify gaps or deficienciesof care in different facilities that can be corrected. This informationcan be provided in real time or near-real time so that adverse patientcare outcomes can be quickly addressed, in contrast to the past whereinformation about quality of care is often analyzed well after anadverse care event has occurred (or even after a patient has beendischarged). Further embodiments of journaling and detecting clinicianinteractions with devices (including via RFID tags) are described ingreater detail in Appendices I through III.

A telemedicine module 224 of the MNS 210 can facilitatetelecommunications between clinicians and patients, includingtelepresence communications where clinicians can diagnosis, treat, orotherwise attend to the needs of patients remotely using audio visualsystems or the like. The telemedicine module 224 can also be used inconjunction with features of the escalation module 218 described belowwith respect to FIG. 8.

FIG. 3 depicts an embodiment of a patient profile configuration process300. The patient profile configuration process 300 can be implemented byany of the medical network services described above, including the MNS110 or 210. In addition, portions of the process 300 can be implementedby other devices in any of the institutions described above, or any ofthe medical devices or clinician devices described above. Thus theprocessing of the process 300 can be distributed amongst differentdevices. However, although different devices including devices otherthan those shown or described herein could implement the process 300,for convenience certain aspects of the process 300 are described asbeing implemented by the patient profile manager 211 of FIG. 2.Advantageously, in certain embodiments the patient profile configurationprocess 300 can facilitate improved monitoring of patients bymaintaining patient profiles from visit to visit, a particularinstitution and/or from visit to visit amongst multiple institutions.

The process 300 begins at block 302 where a patient is admitted to ahospital. In the admission process, the patient may provide demographicinformation to the hospital, including the gender, age, weight, otherhealth conditions that the patient has, medications that the patient ison and so forth. This information can be stored in the EMR describedabove with respect to FIG. 2. In another embodiment, when a patient isadmitted, the patient provides insurance information or otheridentifying information that uniquely identifies the patient and therebyenables the patient profile manager 211 to look up the patient'sprofiled date stored in the MNS 210.

At block 304, the patient is assigned a monitoring device. Themonitoring device may be a bedside device or a body worn device andcould be used in an institution such as a hospital or at the patient'shome or while the patient is mobile. At block 306 the patient profilemanager 211 determines whether the patient has existing alarm settingsprofile in the MNS 210. An existing alarm settings profile may includecustomized alarm settings based on the demographics of the patient.Different types of patients may benefit better from different alarmsettings. For instance, neonates or children may require different alarmsettings from adults because their physiology differs from adults.Likewise, alarm settings can be based on gender, race due tophysiological differences among races (however slight), as well as dueto age and previous medical conditions or medications that a person ison or symptoms that the patient is reporting when admitted to thehospital.

If the patient has an existing alarm settings profile in the MNS, thenthe patient profile manager 211 transmits, uploads, or otherwisedownloads the existing alarm settings profile to the monitoring deviceassociated with the patient at block 308. Thus, it can be seen that anadvantage in certain embodiments of the patient profile manager 211 isthat the existing profile can be stored in the cloud and thereforeaccessed whenever that patient is readmitted to a hospital or otherclinical facility. However, if the patient does not have an existingalarm profile, at block 310 the patient profile manager 211 can identifyan alarm profile template that matches attributes of the patient,including any of the demographic attributes described above. So, forexample, if the patient is a neonate, the patient profile manager 211can access the stored template of alarm settings for neonate.

At block 312, the patient profile manager 211 outputs an option to usethe alarm profile template to a clinician. The clinician can then decidewhether to use that particular template, select a different template, orcustomize the template to meet the needs of the particular patient.Thus, continuing at decision block 314, the patient profile manager 211determines whether the clinician accepts the template. If so, thepatient profile manager 211 transmits, uploads, or otherwise downloadsthe alarm profile template to the monitoring device and provides optionsfor the clinician to modify the template at block 318. Block 318 mayalso be reached after block 308 where the existing alarm settingsprofile is downloaded to the monitoring device. However, if theclinician does not accept the template 314 as described above, at block320 the patient profile manager 211 can provide options for theclinician to manually adjust alarm settings or to select anothertemplate.

In alternative embodiments, instead of downloading or transmittingpatient profiles to devices, each device may already have severalpatient profiles already installed, and the patient profile module 211selects one and assigns it to the device for the particular patient.

FIG. 4 depicts an embodiment of a device profile configuration process400. Like the process 300, the process 400 can be implemented by any ofthe MNSs as described above including the MNS 110 or 210, or any of theother devices described herein. In an embodiment the device profileconfiguration process 400 is implemented by the device profile manager212 of FIG. 2. Accordingly, for ease of illustration the process 400will be described as being implemented by the device profile manager 212although it should be understood that any other device or system couldimplement the process 400. The process 400 can advantageously providecentralized management of patient monitoring devices by the MNS.

At block 402, the device profile manager 212 outputs a deviceconfiguration adjustment user interface. An example of such a userinterface is shown in FIG. 5 and described in greater detail below.Generally speaking, the device configuration adjustment user interfacecan provide functionality for a user, such as a network professional, tomonitor the configuration status of monitoring devices and/or adjustconfiguration status of such devices. Devices may have profilesassociated with them that include information about alarm settings andother settings. Profiles can be patient profiles that are associatedwith devices, clinician profiles that are associated with devices and soforth. In addition, the user interface can enable users to updatesoftware on the monitoring devices.

At block 404, the device profile manager 212 receives a user selectionof a patient monitoring device or other device in the network from theuser interface. The user may select any device shown in the userinterface to obtain more data about that device, e.g., to changesettings on the device or to set policies or rules for the device. Atblock 406, the device profile manager 212 receives user updates to thedevice settings and pushes those updated device settings to the devicesover the network at block 408.

Turning to FIG. 5, an example of a device configuration adjustment userinterface 500 is shown. The example user interface 500 could be outputby the device profile manager 212 according to the process 400. The userinterface 500 can be implemented in a web browser or other applicationsoftware that may or may not be implemented in a web browser.

The user interface 500 includes a device explorer 510, deviceconfiguration pane 520, and a current measurements pane 530. The deviceexplorer 510 includes a tree 512 or hierarchy of facilities and devices,enabling users to select a facility, explore floors or subsections ofthat facility, and select devices within those floors or subsections. Inthe depicted embodiment, the tree 512 shown includes data representing ahospital that has an operating room floor, an intensive care unit (ICU)floor, and a general floor. The operating room floor option is expandedto show devices within the operating room floor. One of the devices 514is shown selected by a user (e.g., using a mouse or touch screen input).

Advantageously, in certain embodiments, the user interface 500 canprovide access to any device that connects to the MNS. Thus, networkadministrators can drill down into any device among several differentfacilities. In addition to a tree view, in some embodiments, other viewsof the devices can be shown, such as a topology view that showsinterconnections between devices in the network.

Upon user selection of one of the devices 514, the device profilemanager 212 can output details 522 of the device 514 in the deviceconfiguration pane 520. These details 522 include configuration settingsabout the device and possibly other information stored on the device,including patient profiles, device profiles, policies, what network thedevice is connected to (not shown), and optionally applicationsinstalled on the device and settings thereof (not shown). These details522 can be selected by a user to adjust the configuration settings ofthe selected device 512. For example, a user can select specific patientprofiles to add or remove to the device.

In one embodiment, each device can have one or more profiles. In oneembodiment, each device has a single device profile that specifies wherein the facility the devices belongs (such as what floor), what networkthe device is connected to, and so forth. Policies can also beassociated with a device and may be part of a device's profile. Policiescan include rules about how a device may be used and may be defined byusers (including clinicians and/or network technicians or themanufacturer of the device). For example, a policy may be defined thatstates that a device is to be used for general floor monitoring and notintensive care or operating room monitoring. Accordingly, if a clinicianattempts to associate the device with a patient in the ICU or operatingroom floor, software in the device (or in the MNS) can detect that thedevice is being used on the wrong floor and therefore may preventoperation of the device or issue an audio/visual warning to not use thedevice. The device or MNS can detect that the device is on the wrongfloor, for instance, by analyzing network traffic to and from the deviceto determine where in the network the device is connected.

Another example of a policy is related to patient profiles. A user candefine a policy that the device may be used only with neonates or onlywith adults. In another example scenario, a user can define a policythat the device will issue a warning if a user changes alarm limits onthe device or changes alarm limits beyond certain thresholds. Anotherpolicy could be defined to state that alarm thresholds cannot be changedon the device unless the device is associated with an existing patientprofile. Software on the device and/or the MNS can enforce the policiesby warning users of violations and/or preventing operation of the deviceuntil the policies are complied with. Accordingly, the policies used indevices can improve patient care outcomes.

Advantageously, in certain embodiments, because the MNS may beimplemented in a centralized cloud architecture, the user interface 500can enable policies, profiles, and settings to be adjusted for aplurality of devices at once instead of one at a time. As a result,network and device maintenance can be streamlined. Likewise, the userinterface 500 can facilitate pushing software updates to multiple of thedevices at once. Example user interface controls 524 are shown, whichare buttons in the depicted embodiment, for adding new profiles,policies, and updating devices.

Moreover, the device profile manager 212 can detect problems occurringin different devices and report these problems or a representationthereof on the user interface 500. In the depicted embodiment, a devicehealth indicator 542 is shown that can reflect the health of a device onthe network. The device health indicator 542 can be a light or graphicthat is green, yellow, or red depending on whether a device isfunctioning well, functioning poorly, or not functioning at all. Otherindicators may be used than a colored light, such as text, a graph, anumber, 1-5 star ratings, or any combinations of the same or the like.The device profile manager 212 can score devices based on deviceperformance and adjust the output of the indicator 542 accordingly.Instead of a separate indicator, a graphic for each device in the deviceexplorer 510 could instead show colors for each device, corresponding tothe health of each device.

The current measurements pane 530 depicts current measurements on theselected device 514 and is optional in some embodiments. A trend viewbutton 532 can allow a user to see trends on these measurements. Likethe device health indicator 542, a patient health indicator 544 is alsoshown that may have some or all of the same functionality as the devicehealth indicator 542 except with respect to a patient. The patienthealth indicator 544 can also be displayed on a medical deviceassociated with the patient, a clinician device remote from the medicaldevice, or a nurse's workstation, to name a few examples. The patienthealth indicator 544 can reflect an overall health or wellness of thepatient and may be based on the wellness index described above. In otherembodiments, the patient health indicator 544 can include or be thewellness index.

FIG. 6 depicts an embodiment of a continuum of care process 600. Likethe process 300, the process 600 can be implemented by the MNS 110 or210, or any of the other devices described herein. In an embodiment, theprocess 600 can be implemented at least in part by the networkmanagement module 202 to facilitate continued patient monitoring when apatient leaves a hospital or other facility.

At block 602, the network management module 202 receives monitoring dataof a patient at the MNS via WiFi, LAN, or other networking technologiesof the clinical facility to which the patient is admitted. Once thepatient is discharged, the patient may be outfitted with a wearable homemonitoring device 604. The wearable monitoring device may be the samedevice used to monitor the patient in the clinical facility. Inaddition, the device may be a mobile device that need not be wearable insome embodiments. The device may, for instance, be any of the devices orvariations thereof described in U.S. patent application Ser. No.13/010,653, filed Jan. 20, 2011, titled “Wireless Patient MonitoringSystem,” the disclosure of which is hereby incorporated by reference inits entirety.

When a patient is discharged, the patient typically leaves the hospitalnetwork. Accordingly, in currently-available systems, there is atypically a period of time where the patient is not being monitored oncethe patient leaves the facility. However, the network management module212 can facilitate continued monitoring of the patient by receivingmonitoring data from the patient via a cellular or satellite network atblock 606. Then, if an alarm condition is detected at block 608, thenetwork management module 212 (or the early warning system 216 using thenetwork management module 212) can pass a notification from the MNS to acare provider 610. Accordingly, the MNS can facilitate a continuum ofcare for a patient and continuous monitoring even when a patient hasleft a clinical facility.

FIG. 7 depicts an embodiment of a situational alarm context process 700.Like the process 300, the process 700 can be implemented by the MNS 110or 210, or any of the other devices described herein. In an embodiment,the situational alarm context process 700 is implemented by the riskanalysis system 218. The situational alarm context process 700 can takeinto account more than just the measured parameters of a patient whendetermining whether to alarm. The process 700 can also take into accountthe situational context of the patient, such as whether the patient ismoving.

At block 702, the risk analysis system 718 receives parameter data fromthe patient monitor while the patient is in bed. When the patient is inbed, the patient is typically resting and may have a lower heart ratethan when the patient is moving, all other factors being equal. However,when the patient moves, the patient's heart rate may elevate, and otherparameters associated with the patient may change as well. It can bedesirable to adjust patient monitoring to account for patient changes inmovement or other situational context to avoid producing false alarms.

Thus, the location and/or motion of the patient are monitored at block704. The location and/or motion of the patient may be monitored inseveral ways. One or more motion sensors may be included in the patientmonitoring device, and the monitoring device may be worn on the patient.Thus, for example, the monitoring device may include a gyroscope,accelerometer, or the like that can determine whether the patient ismoving, walking, or the like. Telemetry can also be used to ascertainwhere a patient is located and/or moving to. For instance, when apatient is wearing a patient monitor that communicates over wirelessnetworks, the MNS can determine the patient's position by triangulationof nearby access points to which the patient's monitoring device issending and receiving signals. In other situations, patients may take anassisted walk with a nurse or other clinician. The nurse or otherclinician may have an RFID tag or the like that can be detected by thepatient monitoring device (as described in Appendix III), giving a clueas to the movement and/or location of the patient.

Thus, the risk analysis system 218 determines at block 706 whether thepatient is ambulatory or moving. If so, the risk analysis system 218 canadjust alarm settings for the patient due to the patient beingambulatory. For example, the risk analysis system 218 can increase aheart rate threshold limit that would trigger an alarm if it detectsthat the patient is ambulatory. If the patient is not ambulatory, theprocess loops back to block 704, where the patient is continued beingmonitored using existing alarm settings.

In other embodiments, the risk analysis system 218 may adjust patientmonitoring differently. Instead of adjusting alarm settings, forexample, the risk analysis module 218 can assign scores to patientsbased on their activity level and incorporate these scores into thewellness index described above. For instance, if the patient is walking,the risk analysis module 218 may lower the weight given to heart rate incalculating the wellness index so as to avoid an increased heart rateadversely impacting the wellness index calculation. The risk analysismodule 218 can also take into account additional factors beforedetermining whether to adjust the weight applied to the heart rate,however, such as the health conditions or diseases of the patient. Ifthe patient has heart disease or some other condition, it may be prudentto alarm or indicate an adverse health condition whenever the patient'sheart rate rises, no matter the activity level of the patient. Thus, therisk analysis module 218 may use the health condition of the patient tooverride other considerations such as patient movement.

FIG. 8 depicts an embodiment of a situational escalation process 800.Like the process 300, the process 800 can be implemented by the MNS 110or 210, or any of the other devices described herein. As describedabove, alarms may be escalated from a primary provider (or group ofproviders) to a secondary provider (or group of providers) if theprimary provider is unavailable to address an alarm. In an embodiment,the process 800 is implemented by the escalation module 218 and enablesclinicians to remotely provide information useful to a secondaryprovider to whom an alarm is escalated.

At block 802, an alarm generated by a monitoring device is received bythe escalation module 218. The escalation module 218 identifies aprimary provider to be contacted by the alarm at block 804. Theescalation module 218 may store a list of providers that are associatedwith a patient and may provide a user interface that enables users toadjust this list in certain embodiments. At block 806, the escalationmodule 218 determines the primary care provider's situational context.If the situational context of the primary care provider is that theprovider is located far from the patient, the escalation module 218 mayperform intelligent escalation as described below.

The situation where the primary provider is far removed from the patientmay occur increasingly more commonly. In particular, as smaller clinicsreplace some functionality of larger hospitals, clinicians may not allbe co-located in the same hospital. Further, modern travel conveniencesmake it possible for surgeons and other specialists to travel to patientsites and vice versa to perform patient care. Accordingly, a primaryprovider may be distant from several of his or her patients.

The escalation module 218 determines at block 808 whether the primarycare provider is located remotely from the patient. If not, theescalation module 218 further determines at block 810 whether theprimary care provider is available. The primary care provider may be offduty or unable to take a page, for example, in which case the escalationmodule 218 escalates the alarm to a secondary provider at block 814.Otherwise, the escalation module 218 can provide the alarm andoptionally data from the monitoring device (such as trend data) theprimary provider for possible in-person intervention at block 812.

However, in the scenario where the primary care provider is not locatedclose by but may be available, the escalation module 218 can stillprovide the alarm and optionally data from the monitoring device to theprimary provider for remote intervention at block 816. The primaryprovider may use telepresence technologies to interact with the patient,e.g., using the telemedicine module 224 of the MNS 210. The escalationmodule 218 can then receive instructions from the primary providerregarding an alarm response at block 818, e.g., through a user interfaceor telepresence technology. These instructions can include a diagnosis,recommended medication, or other recommended course of actions that theescalation module 218 can relay to the secondary provider along with thealarm at block 820.

Thus, in certain embodiments, the process 800 enables a remote primarycare provider to provide instructions to a secondary, local careprovider to better enable the secondary care provider to respond to analarm. This process 800 can therefore improve upon currently-availableprocesses, which typically require the secondary provider (who may beless familiar with the patient than the primary provider) to interpretthe patient's alarm without guidance from the remote primary careprovider.

III. Additional Medical Network Service Embodiments

In addition to the embodiments described above, in certain embodiments,clinician devices (including mobile devices) can interact with the MNSand/or with the patient monitoring devices directly. A clinician'smobile device, for instance, can receive alarms, trend data, parameterdata, or any other data associated with a patient from the MNS ordirectly from the patient monitoring devices. The clinician's device mayalso receive data from multiple patients that are associated with theclinician, including features of the clinician portal described above.Thus, for example, the clinician's device may depict wellness indicesfor the various patients and thereby enable the clinician to triagealarms. The clinician device can also include the capability to silencealarms remotely (e.g., by transmitting an instruction input by theclinician to the patient monitoring device). In an embodiment, theclinician device communicates directly with the patient monitoringdevice using Bluetooth (e.g., if in the same room or nearby) or WiFi oranother wireless technology. In another embodiment, the clinician devicecommunicates with the patient monitoring device through MNS if theclinician (or the clinician's organization) is affiliated with the MNS(e.g., is a paying customer) but otherwise directly communicates withthe patient monitoring device. In the scenario where the clinician isaffiliated with the MNS, the clinician may be able to advantageouslyobtain trend data for a plurality of patients, whereas directlyconnecting to each patient device individually may or may not providethis functionality.

Further, in certain embodiments, each patient device includes a networkcommunications module that enables the patient device to communicatewith the MNS over a network. In anther embodiment, a gateway device (notshown) is provided in each room of a facility, or in a few rooms of afacility, which connects to the patient device and which communicateswith a plurality of devices in the room or rooms. The gateway device mayitself be a patient monitor that includes ports for connecting to otherdevices. The gateway device can receive data from these other medicaldevices and pass the data on to the MNS for storage in the EMR, analysisby the risk analysis module 218, and the like. Some examples of otherdevices in a typical clinical facility that can connect through thegateway device include ventilators, pumps, general oxygen equipment, andthe like. An example gateway device that may be used with the featuresdescribed herein is described in U.S. application Ser. No. 13/651,167,filed Oct. 12, 2012, titled “Medical Monitoring Hub,” the disclosure ofwhich is hereby incorporated by reference in its entirety.

Moreover, any of the features described herein can be implemented inconjunction with features from any of the following applications, thedisclosure of each of which is hereby incorporated by reference in theirentirety: U.S. application Ser. No. 11/633,656, filed Dec. 4, 2006,titled “Physiological Alarm Notification System”; U.S. application Ser.No. 12/904,925, filed Oct. 14, 2010, titled “Systems and Methods forStoring, Analyzing, Retrieving, and Displaying Streaming Medical Data”;U.S. application Ser. No. 12/904,377, filed Oct. 14, 2010, titled“Medical Monitoring System”; U.S. application Ser. No. 13/269,296, filedOct. 7, 2011, titled “Risk Analysis System”; and U.S. application Ser.No. 13/371,767, filed Feb. 13, 2012, titled “Medical CharacterizationSystem.”

IV. Medical Edge Router Embodiments

Turning to FIG. 9, another embodiment of a computing environment 900 isshown for providing clinicians with access to patient care data. Thecomputing environment 900 is compatible with and can be used inconjunction with the features of the computing environment 100 describedabove, as well as with other embodiments described above. For example,the computing environment 900 can provide access to a medical networkservice, such as the MNS 110 or 210. The MNS can be implemented in oneor more network operation centers 970, as shown. Each of the networkoperation centers 970 can be implemented in a separate data center ingeographically dispersed locations so as to provide redundant access andaccess that is geographically proximate to users of the MNS.

One of the major challenges associated with providing network-basedmedical monitoring services for hospitals and other clinical facilitiesis network connectivity. Networks, including the Internet, are prone tonetwork failure and therefore, it can be desirable to provide forredundancy in communication channels or pathways that access the MNS.Advantageously, in the depicted embodiment of FIG. 9, the computingenvironment 900 includes multiple redundant pathways to communicate datafrom point-of-care devices 912 to the MNS in the network operationcenters 970, which will be described herein.

As shown, the point-of-care devices 912 are arranged in a patient area910, which may be a hospital or a subset thereof. The point-of-caredevices 912 can be patient monitoring devices, such as any of thepatient monitoring devices described above, and can monitor anyphysiological parameter of a patient, such as oxygen saturation, bloodpressure, heart rate, ECG parameters, respiratory rates, hemoglobin, andthe like. The point-of-care devices 912 can be bedside devices orbody-worn patient monitoring devices, and in general, may providephysiological parameter data, trend data, alarms and alerts to cliniciandevices over a network. Further, the point-of-care devices 912 canprovide such data outside of a hospital network to clinician devicesover the Internet 950 (or other wide-area network) through a medicaledge router 920.

In the depicted embodiment, the medical edge router 920 communicateswith the network operation centers 970 over multiple communicationpathways, including multiple Internet Service Provider networks 940. Forconvenience, this specification generally refers to the Internet ServiceProvider networks 940 as ISPs. The medical edge router 920 can be anintelligent edge router that provides redundant communications fortransmitting patient data, among other features. For instance, in oneembodiment, the medical edge router 920 can attempt to send patientdata, including physiological parameters, trends and/or alarms, to theMNS in a network operations center 970 over a first one of the ISPs 940.If the first ISP 940 is unavailable, the medical edge router 920 canattempt to communicate with the MNS through a second one of the ISPs940, and so forth, until the medical edge router 920 has attempted tocontact the MNS through most or all of the ISPs 940.

In one embodiment, if the ISPs are unavailable, then the medical edgerouter 920 can attempt to contact the MNS through a wireless ISP 944;for example, by communicating wirelessly through a local access point942, which then communicates via the ISP 944. In other embodiments, themedical edge router 920 can attempt to first communicate throughbroadband mechanisms, such as wired LAN, WAN or wireless orsatellite-based broadband, prior to using dial-up or lower bandwidthlinks. In yet another embodiment, the medical edge router 920 performsback-up communications to clinicians via cellular networks if the ISPs940, 944 are unavailable. In such instances, the medical edge router 920may, for instance, send a text message (via SMS) or email or othercommunication to one or more clinicians that includes some or all of thedata obtained from one or more point-of-care devices 912. Since textmessages and emails tend to be limited in length, the medical edgerouter 920 can instead summarize data obtained from the point-of-caredevices 912 and send the summarized data over the cellular network orother network.

In some embodiments, the ISPs 940 or 944 may be available, but one ormore of the network operation centers 970 that host the MNS may be downand unavailable. Accordingly, it can be useful in such circumstances forthe medical edge router 920 to communicate via SMS or email over one ofthe ISPs 940 or cellular networks (not shown), to clinicians. In anycase, when communicating via SMS or email, the medical edge router 920can reduce the amount of data sent or selectively prioritize the datasent to clinicians, to send higher-priority data in view of the reducedbandwidth available, in such communication of channels. In oneembodiment, for example, the medical edge router 920 can send a summaryof the alarms or parameter values from the point-of-care devices 912 toa clinician via SMS or email or a similar mechanism, without sendingtrend data, which can consume a significant amount of bandwidth. Inanother example, medical edge router 920 prioritizes alarms overparameter values over trend data, such that if an alarm is to betransmitted, the medical edge router 920 can transmit the alarm to aclinician device, instead of more bandwidth-intensive data. If no alarmsare to be transmitted, the medical edge router 920 can transmit morebandwidth-intensive data.

In yet another embodiment, the medical edge router 920 is also connectedto an uninterruptible power supply or UPS 932 that can provide themedical edge router 920 with continued power, should mains power becomeavailable. The UPS 932 can also power other systems in the clinicalfacility, including the point-of-care devices 912 and a local servermirror appliance 930. The local server mirror appliance 930 can be aserver or other computing device that includes some or all of thefunctionality of the MNS described above. In one embodiment, the localserver mirror appliance 930 includes important or critical patient carefunctionality of the MNS. For example, the appliance 930 may include aportion of the functionality of the MNS and may operate in parallel withthe MNS to calculate parameter values or a wellness index in case offailure or inability to contact the MNS over the network.

Also shown is a VPN 960 through which the point-of-care devices 912 canconnect to the network operation centers 970. The VPN 960 can providesecurity for such communications, although the VPN 960 may be optionalin some embodiments.

It should also be noted that in certain embodiments, the computingenvironment 900 of FIG. 9 can include multiple edge routers 920, whichcan be used for failover purposes within the hospital network. Forinstance, each point-of-care device 912 can be connected to two or moreedge routers 920 and can send data over each edge router 920 to reducethe potential of having a single point of failure in the network.

Turning to FIG. 10, a more detailed example of a medical edge router1020 is shown. The medical edge router 1020 can have some or all thefunctionality of the medical edge router 920 described above withrespect to FIG. 9. Various components of the medical edge router 1020shown can be implemented in hardware and/or software. The medical edgerouter 1020 receives input packets and forwards output packets, whichthe medical edge router 1020 can route to an appropriate destination inthe network. The medical edge router 1020 can be placed at the edge of anetwork in or near a clinical facility (see, e.g., FIG. 9) and thereforemay provide access to other networks outside of the clinical facilitynetwork.

The example medical edge router 1020 shown includes a data logger 1021and a routing module 1022 that both receive the input packets. The datalogger 1021 can be a packet-sniffer or the like that copies the inputpackets and thereby makes the input packets available to a trafficinspector 1023. The data logger 1021 may also store the packets forsubsequent analysis, including analysis for determining conditionsleading up to a network communications failure after the failureoccurred. The traffic inspector 1023 can inspect the input packetslogged by the data logger 1021 to determine whether any of the inputpackets include alarms. If an alarm is detected, the traffic inspector1023 can notify the routing module 1022 of such an alarm condition,enabling the routing module 1022 to prioritize the distribution ofpackets that relate to include alarms (including optionally packetshaving parameter data associated with the alarms).

The routing module 1022 includes a failover module 1024 that can receivecommunications from the traffic inspector 1023 about alarms and canselect destinations for the packets accordingly. The routing module 1022also communicates with one or more routing tables 1025 that can bepopulated using any suitable routing protocol, such as the BorderGateway Protocol (BGP) commonly used in routers in the Internet. Therouting module 1022 can route the input packets to appropriate routersor switches in the Internet (or other networks) based on the informationstored in the routing tables 1025. The routing module 1022 can updatethe routing tables 1025 over time, using BGP or another protocol.

The failover module 1024 can provide the redundant failover featuresdescribed above, at least in part, with respect to FIG. 9. For instance,the failover module 1024 can determine whether an ISP or other networkchannel is unavailable and can fail over or escalate communications toanother ISP or communication channel when network channel failure isdetected.

The routing module 1022 can prioritize alarms, as described above, whendetected by the traffic inspector 1023. When an alarm is included in aninput packet, as indicated by the traffic inspector 1023, the routingmodule can prioritize the alarm by broadcasting the alarm over multipleor all channels used by the routing module 1022. For instance, therouting module 1022 can broadcast such packets over multiple ISPs, orover both wired and wireless ISPs, or over both an ISP and a cellularnetwork, or the like.

Packets are sent from the routing module 1022 to a network interfacecard 1030 that can implement the data link and/or physical layers of theTCP/IP network stack. The network interface 1030 includes, in thedepicted embodiment, an Ethernet or wired modem 1032, a wireless (e.g.,WiFi) radio 1034, and a cellular radio 1036. The network interface 1030outputs the output packets based on instructions from the routing module1022. For instance, if the routing module 1022 instructs the networkinterface 1030 to send packets over a wired ISP, the network interface1030 can send such packets via the Ethernet or wired modem 1032.Conversely, if the routing module 1022 instructs the network interface1030 to send such packets via a WiFi or wireless link, the wirelessradio 1034 of the network interface 1030 can transmit such packets.Similarly, the cellular radio 1036 can transmit certain packets overcellular networks (such as SMS packets), as instructed by the routingmodule 1022. The components of the network interface 1030 are examplecomponents only and could be added to or removed from in otherembodiments.

In the depicted embodiment, the medical edge router 1020 also includes aloudspeaker 1026 and a display 1027. The loudspeaker 1026 can outputaudible alarms when network connectivity is detected as being down bythe medical edge router 1022. For instance, whenever an ISP becomesunavailable, or another network communications channel becomesunavailable, the routing module 1022 can cause the loud speaker 1026 toissue an audible alarm. Likewise, the display 1027 can output visualalarms in response to the routing module 1022 detecting a networkcommunication path being unavailable, enabling network personnel totroubleshoot the medical edge router 1020 when needed. The medical edgerouter 1020 can also send SNMP packets to IT personnel to alert ITpersonnel of network failures, failover conditions, and the like.

In addition, the medical edge router 1020 can also include a precisiontime service 1028 that can apply time stamps to packets sent by therouting module 1022. This precision time service 1028 can besynchronized or substantially synchronized with time services used byother medical edge routers 1020 in the hospital network or in otherhospital networks remote from the medical edge router 1020 shown.Accordingly, packets received by the MNS in any one of the networkoperation centers 970 can maintain a synchronous or time-ordered view ofthe packets. It can be beneficial to maintain a synchronous ortime-ordered view of medical data received from the point-of-caredevices 912 to ensure or attempt to ensure that alarms and other dataare received in the proper time order, so that clinicians can takeappropriate action based on such data.

In one embodiment, the precision time service 1028 communicates with oneor more GPS satellites to obtain a precision time value. In anotherembodiment, the precision time service 1028 communicates with an atomicclock, or the like, to obtain a precision time value, although othertechniques may be used to obtain precision time values.

The medical edge router 1020 can have many other features than thoseshown in FIG. 10 (or fewer features). For instance, the medical edgerouter 1020 can monitor or manage performance of the local clinicalfacility network. Multiple medical edge routers 1020 can be included inor in communication with a single facility, such as a single medicaledge router 1020 for each hospital floor. Many other embodiments arepossible.

Turning to FIG. 11, an example edge router failover process 1100 isshown. The edge router failure process 1100 can be implemented by theedge router 920 or 1020 described above and can advantageously providefor redundancy in hospital network communications. While the process1100 will be described with respect to the medical edge router describedabove for convenience, it should be understood that the process 1100could be implemented by any computing device or network device.

At block 1102, the edge router attempts to communicate with the medicalnetwork service (MNS) through a first ISP. At block 1104, the medicaledge router determines whether the ISP is available. If so, the edgerouter is able to communicate its message to the MNS, and the process1100 ends. However, if the ISP is not available, then the medical edgerouter determines at block 1106 whether all ISPs are unavailable, orwhether the MNS is not responding. If all ISPs are unavailable, it maybe helpful for the medical edge router to contact the MNS using anothercommunication pathway, such as cellular or wireless. However, some ISPsmay be available while the MNS is not responding, in which case it mayalso be useful to use a different communication pathway to providepatient information to clinicians.

If all ISPs are unavailable or the MNS is not responding, then the edgerouter can attempt to communicate with the MNS through the next ISP atblock 1108, looping back to block 1104. However, if all ISPs areunavailable or the MNS is not responding, then the edge router can sendreduced data to the clinicians via an alternative mechanism, such asemail or SMS, at block 1110. For example, the edge router can transmit asummary of patient monitoring data over a cellular network or via emailto clinicians. In one embodiment, in response to detecting that all IPSsare unavailable or the MNS is not responding, the routing module 1022sends a request to the local server mirror appliance 930 or the point ofcare devices 912 for a summary of the patient monitoring data. Then,upon receipt of the summary data, the edge router can communicate thesummarized data over an alternative communications channel. In otherembodiments, the local server mirror appliance 930 and/or the point ofcare devices 912 send summary data to the edge router together with moreverbose patient monitoring data so that the edge router can send thesummary data without delay in case of communications pathways to the MNSor clinicians becoming unavailable.

Turning to FIG. 12, an example embodiment of an edge routeralarm-handling process 1200 is shown. The edge router alarm-handlingprocess 1200 can also be implemented by either of the edge routers 920or 1020 described above, and for convenience, will be described withrespect to the medical edge router, although the process 1200 could beimplemented by any computing device or network device.

At block 1202, the edge router receives input packets, and at block1204, analyses those input packets to identify any patient monitoringalarms. For instance, the traffic inspector 1023 of the edge router 1020can identify any patient monitoring alarms in a given packet. In oneembodiment, the traffic inspector 1023 searches for a particular payloadin a packet that indicates that an alarm is in the packet, and inanother embodiment, alarm information is included in a header of thepacket.

If an alarm is detected at block 1206, the traffic inspector 1023 sendsthe alarm over multiple communication channels for redundancy at block1208, such as over multiple ISPs, or over a wired ISP and a wirelessISP, or over an ISP and over a cellular network, combinations of thesame, or the like. If an alarm is not detected at block 1206, then theprocess 1200 can loop back to 1204, effectively allowing the trafficinspector 1023 to continue to monitor for the presence of alarms.

V. Terminology

Many other variations than those described herein will be apparent fromthis disclosure. For example, depending on the embodiment, certain acts,events, or functions of any of the algorithms described herein can beperformed in a different sequence, can be added, merged, or left out alltogether (e.g., not all described acts or events are necessary for thepractice of the algorithms). Moreover, in certain embodiments, acts orevents can be performed concurrently, e.g., through multi-threadedprocessing, interrupt processing, or multiple processors or processorcores or on other parallel architectures, rather than sequentially. Inaddition, different tasks or processes can be performed by differentmachines and/or computing systems that can function together.

The various illustrative logical blocks, modules, and algorithm stepsdescribed in connection with the embodiments disclosed herein can beimplemented as electronic hardware, computer software, or combinationsof both. To clearly illustrate this interchangeability of hardware andsoftware, various illustrative components, blocks, modules, and stepshave been described above generally in terms of their functionality.Whether such functionality is implemented as hardware or softwaredepends upon the particular application and design constraints imposedon the overall system. The described functionality can be implemented invarying ways for each particular application, but such implementationdecisions should not be interpreted as causing a departure from thescope of the disclosure.

The various illustrative logical blocks and modules described inconnection with the embodiments disclosed herein can be implemented orperformed by a machine, such as a general purpose processor, a digitalsignal processor (DSP), an application specific integrated circuit(ASIC), a field programmable gate array (FPGA) or other programmablelogic device, discrete gate or transistor logic, discrete hardwarecomponents, or any combination thereof designed to perform the functionsdescribed herein. A processor can be a hardware processor comprisingdigital logic circuitry. Further, a processor can be a microprocessor,but in the alternative, the processor can be a controller,microcontroller, or state machine, combinations of the same, or thelike. A processor can also be implemented as a combination of hardwarecomputing devices, e.g., a combination of a DSP and a microprocessor, aplurality of microprocessors, one or more microprocessors in conjunctionwith a DSP core, or any other such configuration. Although describedherein primarily with respect to digital technology, a processor mayalso include primarily analog components. For example, any of the signalprocessing algorithms described herein may be implemented in analogcircuitry. A computing environment can include any type of computersystem, including, but not limited to, a computer system based on amicroprocessor, a mainframe computer, a digital signal processor, aportable computing device, a personal organizer, a device controller,and a computational engine within an appliance, to name a few.

The steps of a method, process, or algorithm described in connectionwith the embodiments disclosed herein can be embodied directly inhardware, in a software module executed by a processor, or in acombination of the two. A software module can reside in RAM memory,flash memory, ROM memory, EPROM memory, EEPROM memory, registers, harddisk, a removable disk, a CD-ROM, or any other form of non-transitorycomputer-readable storage medium, media, or physical computer storageknown in the art. An example storage medium can be coupled to theprocessor such that the processor can read information from, and writeinformation to, the storage medium. In the alternative, the storagemedium can be integral to the processor. The processor and the storagemedium can reside in an ASIC. The ASIC can reside in a user terminal. Inthe alternative, the processor and the storage medium can reside asdiscrete components in a user terminal.

Conditional language used herein, such as, among others, “can,” “might,”“may,” “e.g.,” and the like, unless specifically stated otherwise, orotherwise understood within the context as used, is generally intendedto convey that certain embodiments include, while other embodiments donot include, certain features, elements and/or states. Thus, suchconditional language is not generally intended to imply that features,elements and/or states are in any way required for one or moreembodiments or that one or more embodiments necessarily include logicfor deciding, with or without author input or prompting, whether thesefeatures, elements and/or states are included or are to be performed inany particular embodiment. The terms “comprising,” “including,”“having,” and the like are synonymous and are used inclusively, in anopen-ended fashion, and do not exclude additional elements, features,acts, operations, and so forth. Also, the term “or” is used in itsinclusive sense (and not in its exclusive sense) so that when used, forexample, to connect a list of elements, the term “or” means one, some,or all of the elements in the list. Further, the term “each,” as usedherein, in addition to having its ordinary meaning, can mean any subsetof a set of elements to which the term “each” is applied.

While the above detailed description has shown, described, and pointedout novel features as applied to various embodiments, it will beunderstood that various omissions, substitutions, and changes in theform and details of the devices or algorithms illustrated can be madewithout departing from the spirit of the disclosure. As will berecognized, certain embodiments of the inventions described herein canbe embodied within a form that does not provide all of the features andbenefits set forth herein, as some features can be used or practicedseparately from others.

What is claimed is:
 1. A system for escalating a patient monitoringalarm, the system comprising: a memory comprising processor-executableinstructions stored thereon, the processor-executable instructionspertaining to alarm escalation; and a hardware processor configured toexecute the processor-executable instructions pertaining to alarmescalation in response to receiving an alarm and data from a patientmonitoring device based on at least a measured physiological parameterof a patient, wherein the hardware processor is configured to: prior toreceiving the alarm, adjust an alarm setting for the patient based on areceived electronic indication that the patient is moving; designate,based on data stored in the memory, specific first and second careproviders who have been previously associated with the patient in thememory; electronically determine a situational context of the first careprovider; in response to determining the situational context of thefirst care provider indicates the first care provider is available butlocated remote from the patient, thereby precluding possible in-personintervention in response to receiving the alarm and data from thepatient monitoring device, and that the second care provider is locatedclose by the patient, thereby allowing possible in-person interventionin response to receiving the alarm and data from the patient monitoringdevice, transmit, to the first care provider, the alarm and datareceived from the patient monitoring device; subsequent to saidtransmitting, present to the first care provider a user interface thatallows input of a recommended course of action; electronically receive arecommended course of action from the first care provider regarding thealarm via the user interface or telepresence technology, therebyallowing the first care provider to remotely intervene in response tothe first care provider receiving the alarm and data from the patientmonitoring device, wherein the telepresence technology allows the firstcare provider to interact with the patient; escalate the alarm bytransmitting the recommended course of action and the alarm to thesecond care provider; and in response to determining the situationalcontext of the first care provider indicates that the first careprovider is unavailable, automatically escalate the alarm to the secondcare provider by transmitting the alarm to the second care provider. 2.The system of claim 1, wherein the hardware processor is furtherconfigured to store an alarm setting associated with the patient in acloud data store.
 3. The system of claim 1, wherein the instructioncomprises a diagnosis and a medication recommendation.
 4. The system ofclaim 1, wherein adjusting an alarm setting for the patient is furtherbased on a health condition of the patient.